The role of synthetic and biological prostheses in reconstructive pelvic floor surgery

Uterovaginal prolapse and urinary incontinence are common problems whose pathogenesis remains unclear. As life expectancy increases, significantly greater numbers of women will present with pelvic floor prolapse and incontinence requiring surgical intervention. Currently, the lifetime risk of undergoing prolapse or continence surgery in the USA is one in 11, and up to 30% of patients will require repeat prolapse and 10% repeat continence surgery. In an attempt to improve surgical outcomes and to preserve vaginal capacity and coital function, a number of synthetic and biological prostheses have been developed. This review aims to look at the controversies that exist as the 'ideal' prosthetic material is developed.

The recent literature has reflected the increasing interest in the use of biological prostheses (Allograft/Xenograft) and synthetic absorbable meshes. There has been a focus on the risk factors for erosion seen with the use of synthetic non-absorbable material and a review of techniques for the reduction and management of this complication. The advent of mesh placement in minimally invasive continence surgery (tension-free vaginal tape, intravaginal sling, and Supra Public ARC) is now seeing surgical success to 5 years, but the reporting of complications remains inconsistent.

The use of prosthetics in pelvic floor and continence surgery is an evolving field. Further randomized controlled trials are required to evaluate the role of both biological and synthetic prostheses in reconstructive surgery, to determine which type of prosthesis is most suitable for specific procedures. Prosthetic reinforcement should not be used to replace good surgical techniques.